Final Essay/Project for Webpage

 

The final project will entail that you "redo" your first three essays if necessary to improve their narrative qualities. As all of you may see from my comments, this means that as much as possible, you allow the "voices" of your "sources" (informants, interviewees, posters, self) speak, rather than you as the interpreter, or interviewer. Your voice (except in the initial assignment) is in the background as an "organizing" device. You set themes, steer analysis and interpretation, etc.

1. There should be no interview questions in your writing. 

2. If at all possible, let informants words make your points (rather than you make the points and have the words of others illustrate them)

3. Organize your writing so that points are highlighted rather than the interview process, ordering, etc.

4. Use Pseudonyms instead of real names to protect the anonymity of your informants and yourself  

The final paper should be in the following format:

• 12 point font, Times Roman, SINGLE SPACED
• Quote blocks (loger quotes) should be indented, don't need quotation marks and should be separated by a space from the paragraphs/quotes above and below
• No bold, for emphasis use CAPS
• proofread for spelling please (computer does this for you)
• Each section subject heading is in Bold 14 point, Times Roman font
• Autoethnography of COVID-19
• Social Media and Cultural Experience
• On the Fronlines
• Stigma and Illness
• Word, no PDF, make sure it is accessible to everyone

DUE SATURDAY, December 12. Cannot be late!!!!

Alternative Medicine and Medical Anthropology

Why is there alternative medicine?

antivaxxers and covid (here and here and here and finally here)

• The view that biomedicine should be the only legitimate practice of healing has been challenged.
• alternative healing is not a fashionable trend, it is a WELL-ESTABLISHED CULTURAL STRATEGY and a dynamic, heterogenous feature of most contemporary medical landscapes---a way that people seek to maximize their chances for wellbeing and adapt to the rapidly changing and unfavorable circumstances, by drawing on multiple sources and resources of knowledge and authority.
• WHAT IS IT?-hard to define
• there is such a variety of options which are quickly disseminated on the internet and an integration of various alternatives with biomedicine
• ORTHODOX (biomedicine) defended from "heroic medicine " of the colonial era, which endorsed aggressive measures such as sweating, purging, and toxic drugs. It was in contrast to heterodox medicine "sects" which upheld the gentler methods and the view that healing involved the strengthening of ones VITAL FORCE and required more than just mechanistic interventions
• homeopathy-
• the treatment of disease by minute doses of natural substances (distillations) that in a healthy person would symptoms of disease
• botanic medicine-
• use of healing through plants and other natural compounds
• osteopathy-
• healing through the manipulation of the bones of the body.
• hydropathy-
• the treatment of illness through the use of water, internally and externally (baths, steams & spas)
• chiropractic-
• like osteopathy, but focusing on spinal misalignments
• Christian Science-
• sin and illness are illusions that can be overcome by prayer. refuse any other intervention
• various folk medicines
• The practice of alternative therapies has always been deeply rooted in in class and ethnic distinctions and relations, and therefore a highly political process
• they have also become VENUES OF CULTURAL CRITICISM AND RESISTANCE and EMPOWERMENT in many parts of the world
• What constitutes the mainstream at any one particular time may be questionable or alternative a century later
• leeches
• blood letting
• electric shock
• hysterectomy
• zoo-therapies (Parasites ingested for Crohn's disease, e.g.)
• saltwater rinses and gargles
• neti pot or ear candeling
• Practices that originate elsewhere until they become familiar are always alternative
• Chinese medicine
• acupuncture
• DOUBLE-BLIND PLACEBO CONTROLLED MEDICAL TRIALS (gold standard for in Western medicine) are elaborate and expensive, so rarely available to prove the efficacy of alternative therapies
• SO..."different from the usual or conventional: existing or functioning outside the stablished cultural, social, or economic system" ALTERNATIVE
• subversive
• grassroots
• lack of standardization
• Sickness and suffering are not just natural processes. They are socially produced and shaped by local and global patterns of social inequality and power relations.

THE RISE OF INTEGRATIVE MEDICINE

• 1 in 3 people in the US use some sort of alternative therapy
• ethnographic studies have shown that traditional practices and beliefs involving health, illness and healing were NEVER fully extinguished. They live on, though they may be frowned upon
• are we in "a golden age of quackery"?
• governments are eager to assess and regulate these practices which can provide additional sources of income and novel cost containment solutions, as the cost of biomedicine rises.
• DANGERS OF MAINSTREAMING CAM?
• the loss of self-help and grass-roots ethos that have historically characterized alternative medicine-EXPENSIVE (as practitioners become bureaucratized, professionalized and commercialized they become luxuries for the wealthy)
• practitioners are understandably distrustful of biomedical specialists getting training and licenses in  hybrid, inauthentic fields like "oriental medicine" so that they can compete in the market

THE ANTHROPOLOGICAL APPROACH

•  explores the diversity of popular methods in cultural context
• seeks to clarify the VALUE and MEANING that these methods contribute to the lives of patients, practitioners, and communities
• seeks to understand how these meanings and values (etiologies) and therapeutic methods are constructed, imagined or contested in time and space.
• seeks to validate the experiences and testimonies of non-biomedical therapies rather than prove or disprove their objective validity in quantitative terms

THEMES TO BE EXPLORED

• diverse approaches to health and illness and healing engage mindful social , and political bodies which are shifting and permeable
• flow and circulation are central to biological and social life, wellness and healing.
• healing experiences are mediated through EMOTION, INTER-RELATIONS, MOVEMENT, SENSUAL EXPERIENCE, while they are rooted in local contexts
• the senses act and interact with the world in dynamic and complex ways. Their role in healing goes well beyond current Western conceptions and approaches

HISTORY OF ANTHROPOLOGY & MEDICINE

• Western medical training prioritizes the workings of the MACROSCOPIC PHYSICAL & BIOLOGICAL SCIENCES, and the notion of the NEUTRAL OBSERVER.
• This makes Western medical students and doctors uneasy with models that do not employ these notions. (non-Western systems) 
• if you cant measure and compare it, it aint real!
• medical anthropology developed out of the attempt to understand the health-related beliefs and practices in their local cultural context.
• medical anthropologists explore culturally situated ideas, norms and practics related to health and illness, natural and supernatural. 
• health and healing are approached as CULTURAL CONSTRUCTS (not scientific facts), expressed symbolically through language, informed by particular historical, socioeconomic, and political circumstances. 

HEALING AND THE POWER OF AGENCY

• the ability to heal confers high status in all societies (social and cultural)
• traditional healers are often born into families or lineages of healers and apprentice through family members who are also healers 
• may be "odd" people or have an ecstatic experience early in life, suffer from unusual conditions (epilepsy) or show signs of special healing powers from birth
• Western medicine believes in a SINGLE CURE for every illness, so it is difficult for us to understand the traditional healers may suggest a number of different herbal cures, for instance.
• Herbal medicine (traditionally)
• different parts of the same plant prepared in different ways and used in different combinations with other aspects of curing are used for different purposes 

• In Western hierarchtical medical systems, the distance between patient and biomedical doctors is vast and communication is impeded by terminology and social awkwardness, such as hesitancy of patients to ask questions. 

THE DOCTOR PATIENT RELATIONSHIP AND THE ROLE OF THE PATIENT

• Models:
• ENGINEERING MODEL
•  patient directs his/her own care; doctor assists
• this model has the highest agency of the patient and is now beginning to be encouraged , has led to the rise of CAM
• PRIESTLY MODEL
•  patient is passive, trusting and obedient; doctor has full authority
• paternalistic
• describes traditional western medicine
• CONTRACTUAL MODEL
•  legal agreement between to parties who share the same goal
• COLLEGIAL MODEL 
•  trust between patient and doctor with equal effort

• THE SICK ROLE (in sociology-Parsons)

• Parsons was a functionalist sociologist, who argued that being sick means that the sufferer enters a role of 'sanctioned deviance'. This is because, from a functionalist perspective, a sick individual is not a productive member of society. Therefore this deviance needs to be policed, which is the role of the medical profession. 
  
  • The general idea is that the individual who has fallen ill is not only physically sick, but now adheres to the specifically patterned social role of being sick. 
  • ‘Being Sick’ is not simply a ‘state of fact’ or ‘condition’, it contains within itself customary rights and obligations based on the social norms that surround it. 
  • The doctor patient role is inherently hierarchical 
  • The theory outlined two rights of a sick person and two obligations:
• Rights:
  • The sick person is exempt from normal social roles
  • The sick person is not responsible for their condition

• Obligations:
  • The sick person should try to get well
  • The sick person should seek technically competent help and cooperate with the medical professional

AGENCY: CAM versus BIOMEDICINE

• CAM practitioners spend more time with patients perceptions and experience of illness.
• individualized attention, and a greater willingness to listen to patents concerns have contributed to the popularity of many alternative therapies (Mediation) >Agency

• BIOMEDICINE: spend little time with patients
• seek to elicit specific complaints  (symptoms)dominate conversations and expect unswerving obedience from patients (Coercion) <Agency

CULTURAL CONSTRUCTIONS AND WHY THEY MATTER TO HEALTHCARE 

• drapetomania, hysteria, onanism...and...
• speaking against a repressive state=mentally ill
• alcoholism ? PTSD? PMS? "pre-diabetes"? 
• These are created, deleted and legitimated through overt and covert channels of power...as are policies, programs and drugs to treat them.
• resources and blame are also redirected, everyone is encouraged to take stock and seek treatment
• deeply embedded in modern capitalist society

CORE CONCEPTS IN ANTHROPOLOGY

• BIOMEDICAL PERSPECTIVE: health : the absence of disease -NEGATIVE
• disease: the malfunction or disturbance, usually physical or biochemical in nature
• may have a disease (arthritis) but feel "healthy...never hurt and visa versa
• HOLISTIC PERSPECTIVE: health is a state of harmony and balance and wellbeing (includes physical as well as emotional, mental, social and spiritual aspects of a person) -POSITIVE
• from the holistic perspective if someone is feeling ill, something is out of balance-there is disharmony
• roots of suffering are social, emotional or supernatural, depending on your cultural beliefs
• healing traditions have a way of addressing the discomfort and re-balancing a person to restore health. HEALTH IS A NATURAL STATE
• analogy of beauty: if beauty is defined in positive terms as harmonius and balanced or pleasant appearance, those blemishes may matter less.

FIVE MODELS OF HEALTH (Owen)

1. PATHOGENIC MODEL: looks at an external cause (aetiology)
2. BIOLOGICAL MODEL: focuses on symptoms, recognizing that a single cause may produce different effects in different systems
3. HOLISTIC MODEL: many aspects of the patient and the environment are involved and connected through a mutual feedback, and that illness may be necessary to affect a change in that environment or person
4. HOLOGRAPHIC MODEL: symptoms reflect the "whole picture" and the "essence of the person" no matter where they occur in the body
5. RELATIONAL MODEL: highlights the role of the "context" of symptoms and the patients relationships, including the relationship with the healer

disease (biological) versus illness (subjective experience)?????? regardless of whether there is confirmation of the illness or not, to the sufferer it represents the personal and social experience of malfunction or discomfort in particular cultural contexts

the EXPERIENCE of illness is based on the cultural context of illness and suffering.

CURING OR HEALING:

• HEALING

• Healing is the therapeutic process or action that addresses the whole suffering person and the illness rather than just the specific body part or a particular problem-includes emotional, mental, social and spiritual needs and concerns in the treatment plan. 
• Healing aims at bringing about improvement 
• no enemy, nothing to be destroyed, making whole- may not return to original state

• CURING

• Curing has the goal of removing a particular problem completely and permanently, whether that may be a disease, social or spiritual disorder mental or emotional dysfunction, etc.
• curing aims to eliminate condition, healing aims to restore balance
• in traditional settings, FAMILY and COMMUNITY are usually involved in healing and curing.
• biomedicine: kill the enemy, elimination or destruction of external illness-return to original state

Harikari: suicide as social healing in japan-since the ki resides in the abdomen ( and it redresses social imbalance and disruption through dishonor)

BIOMEDICINE VERSUS TRADITIONAL MEDICINE (summary)

• Biomedicine
• employs mechanical model of the human body
• treats each organ and each person in isolation
• emphasizes causation and responsibility (blame)
• sees TARGET MEASURES for health (height, weight, red blood cell count, blood pressure
• focus is on "magic bullet" (drug)
• Ethnomedicine
• illness results from a complex combination of natural and supernatural causes
• requires a combination of therapies to achieve a cure
• aim is to restore harmony (which may not be original state)
• no magic bullet, community and family are important considerations (social world)

NORMALITY:

• normality is shaped by cultural forces
• MEDICALIZATION -what used to be normal can come under the domain of biomedicine and medical surveillance
• pregnancy and child birth
• aging
• menstruation (the curse)
• constitutional states
• alcoholism
• ADHD
• PMS
• altered states of consciousness
• infertility
• defiant disorders
• "micromastia" small breasts
• menopause (hormone deficiency)

• "TYRANNY OF NORMAL" overemphasis on "normality" that leads to excessive interference with the minds and bodies of people who do not meet these measures, or social stigma
• abort abnormal fetuses (Dwarfism)
• Southern Europe and Middles East: light eyes: give the evil eye, red hair=witchcraft
• Africa: albinos: may be kidnapped and killed for their body parts (magical)
• CORRECT ABNORMALITIES MEDICALLY IF WE CAN
• south africa: schizophrenia=healer
• PLACEBO: the "nothing" given of the placebo is far from nothing at all...it is the impact of the anticipation, meaning, and cultural context of healing-GENUINE AND POWERFUL HEALING FORCE IN ITS OWN RIGHT
• The nocebo effect is the adverse reaction experienced by a patient who receives a nocebo. Conversely, a placebo effect is an inert substance that creates either a beneficial response or no response in a patient. The phenomenon by which a placebo creates a beneficial response is called the placebo effect. In contrast to the placebo effect, the nocebo effect is relatively obscure. 
• Both nocebo and placebo effects are psychogenic. Rather than being caused by a biologically active component of the placebo, these reactions result from a patient's expectations and perceptions of how the substance will affect him or her. Though they originate from psychological sources, nocebo effects can be either psychological or physiological. 

 GENDER AND MEDICINE

• women
• more likely to be accused of witchcraft when they are successful in ways that are not available for women
• Reproduction: regulated
• women's bodies :regulated more than men's

TWO TYPES OF ILLNESSES RECOGNIZED IN ANTHROPOLOGY

• NATURALISTIC
• emphasize the physical body and the environment as causative and therapeutic agents 
• unintentional harm
• PERSONALISTIC
• prioritize the role of social and supernatural factors
• tend to point to intentional harm

FACTS and TRUTHS: understanding others

• EMIC vs ETIC perspectives
• post-rationalism: holds that there is no one truth, but many truths, so there is an interest insharing perspectives and experiences in CAM and alternative medical camps (KLASS)
• growing mindset in American culture which allows people to believe in and make use of alternative practices while also using biomedicine

HYGIENE HYPOTHESIS:

• biomedicine has waged a war on viruses, bacteruia and parasites, but can some of these be beneficial? Can soone be "healthy" with these present?
• MODERN LIFE is seen as the cause of many diseases instead (asthma, fibromyalgia, allergiescrohn's disease. HYGEIENE itself is to blame
• the birth canal: what is lost in a C-section?
• what is killed with antibacterial soaps?
• what is good about kids getting pin-worms?
• what is lost in genetic engineering of food plants and commodification of seeds by bio corporations?

CRITIQUE OF WESTERN SPIRITUALITY/WELL-BEING (Richard King)

• "spirituality" in the West are a"silent takeover of religion and Asian wisdom traditions by the forces of market capitolism which promote INDIVIDUALISM and CONSUMERIST SPIRITUALITIES"
• Yoga & Toaism originally sought to extinguish self-centeredness and the attachment to material things while fostering RENUNCIATION COMPASSION and SIMPLICITY-
• have been adopted and rebranded for Western tastes and agendas; becoming primary tools for HEALTH, LONGEVITY, and PROFESSIONAL ACHIEVEMENT.

• The World's Traditional Religions and practices provide a vital source for RESISTANCE to the way that these forces are operating in biomedicine (unrestrained commercialism & commodification of life itself)
• ALTERNATIVE MEDICINES arise from these traditions, creating hybrid therapies

Hallucinogens and Alternative Narratives: Variety of Hallucinogens are used indigenously

• Mecaline
• mushrooms
• Psilocybin 
• LSD

Active Ingredients:

• similar to neurotransmitters in the human body. 
• therapist or shaman acts as a GUIDE to help the patient integrate the experiences within the larger life context
• uses ritual, mythic, and symbolic elements to change the patient's awareness of self and break up habitual experiences of the world (become more suggestible)

WINKELMAN: Therapeutic uses for hallucinogens:

• effecting neural, sensory, emotional, and cognitive processes
• can be effective in treating ADDICTIONS due to their ability to induce the RELAXATION RESPONSE, enhance THETA WAVE PRODUCTION, and stimulate endogenous opted and sterotogenic mechanisms and their MOOD ELEVATING effects.
• shamanic drumming approach to treating addictions 

FAITH HEALING

• ritual healing and religious pilgrimage
• COMMUNITAS: collective consciousness which emerges during religious ritual, infusing the community with power and solidarity
• health and longevity benefits of social involvement
• ECSTACY/ENSTACY: (Eliade) Ritual offers humans the opportunity to renew themselves and the world around them by uniting with the divine through ritual action
• example: girls puberty rituals as healing among the Apache
• PILGRIMAGE (Turner): pilgrimage is a breach of time and space
• when social order is temporarily suspended or challenged-possibility for great change-personal and communal.
• LIMINALITY: socially ambiguous states often incorporating hardships or chjallenges into transitions
• exorcism
• pilgrimage (extended period of liminality)-Vietnam War to the Wall, Hajj to Mecca (path of Mohammed), Kumbh Mela (Allabbad), Lourdes---
• identity differennces suspended, communitas, modifications of perceptions & consciousness, possibility of transformation & healing
• sickness=sin: cure is to be "touched" by sacred-object, person, place
• healing restored or enhanced social status
• suffering is remade into a meaningful and powerful narrative in culture
• miracles
• vision quest
• sweat lodge
• drum circle
• ritual has the potential to rejuvenate self and society

The Stigma of Contagious Disease

COVID-19 read  and HERE

And this Video, HERE

HIV/AIDS

Facts about HIV Stigma

What is HIV stigma?

HIV stigma is negative attitudes and beliefs about people living with HIV. It is the prejudice that comes with labeling an individual as part of a group that is believed to be socially unacceptable.

Here are a few examples:

• Believing that only certain groups of people can get HIV
• Making moral judgments about people who take steps to prevent HIV transmission
• Feeling that people deserve to get HIV because of their choices

What is discrimination?

While stigma refers to an attitude or belief, discrimination is the behaviors that result from those attitudes or beliefs. HIV discrimination is the act of treating people living with HIV differently than those without HIV.

Here are a few examples:

• A health care professional refusing to provide care or services to a person living with HIV
• Refusing casual contact with someone living with HIV
• Socially isolating a member of a community because they are HIV positive
• Referring to people as HIVers or Positives

What are the effects of HIV stigma and discrimination?

HIV stigma and discrimination affect the emotional well-being and mental health of people living with HIV. People living with HIV often internalize the stigma they experience and begin to develop a negative self-image. They may fear they will be discriminated against or judged negatively if their HIV status is revealed.

“Internalized stigma” or “self-stigma” happens when a person takes in the negative ideas and stereotypes about people living with HIV and start to apply them to themselves. HIV internalized stigma can lead to feelings of shame, fear of disclosure, isolation, and despair. These feelings can keep people from getting tested and treated for HIV.

What causes HIV stigma?

HIV stigma is rooted in a fear of HIV. Many of our ideas about HIV come from the HIV images that first appeared in the early 1980s. There are still misconceptions about how HIV is transmitted and what it means to live with HIV today.

The lack of information and awareness combined with outdated beliefs lead people to fear getting HIV. Additionally, many people think of HIV as a disease that only certain groups get. This leads to negative value judgements about people who are living with HIV.

------COVID

Vaccines, Treatments and Inequality

Will the Development of Treatments and Vaccines resolve our HealthCrisis?

STATS TRACKER FOR VACCINES AND TREATMENTS HERE

• Vaccines and Inequality
• Two functions of vaccines: they protect against infection, and reduce transmission
• Equitable vaccine distribution is essential to achieving herd immunity
• The development of candidates for Covid-19 vaccines is progressing faster than that for any other pathogen in history. According to the World Health Organization (WHO), there are already two clinical trials underway and more than 50 vaccine candidates in clinical evaluation. 
• Multilateral institutions funded by multiple governments, pharmaceutical companies, and philanthropists are all pouring hundreds of millions into the vaccine development effort, which has helped hasten discovery. 
• We also have vital international alliances such as the Coalition for Epidemic Preparedness Innovations (CEPI), which was set up in the aftermath of the Ebola crisis and is dedicated to financing and coordinating the development of vaccines and ensuring fair global access.
• Alongside the expedited discovery process, we need to plan for equally expedited distribution and delivery. 
• Those involved in investing and building delivery systems must work as quickly as those in the field of discovery to pave the way ahead and learn from prior vaccine delivery experiences.

One of the main concerns about a potential future vaccine is that it will only be available to the highest bidders – developed countries that have the financial resources to make bilateral deals with pharmaceutical companies to buy large amounts of doses once a vaccine is developed. This could prove problematic to achieve global herd immunity, since some populations will be more protected than others. 

• Historically, vaccines, once developed are distributed to wealthier nations first while the rest of the world's population waits DECADES (if ever) to get access. Will we repeat the mistakes of the past with the COVID-19 vaccine?
• Polio: Eradicated from the developed world in 1960s. It was not until August 2020, that the last case of polio was recorded on the African continent. Cases still exist in Afghanistan and Pakistan today.
• TB killed more than 1.4 million people last year, despite the fact that a vaccine was produced over a century ago
• Measles: in 2018, killed 140,000 children, 1 in 7 children worldwide do not receive the vaccine.
• Since COVID-19 is so highly infectious, the success of eradication will depend on the "weakest link" Unless the virus is eradicated in the poorest parts of the world, the virus will keep spreading and outbreaks will continue.
• xenophobia? Fear of immigrants with diseases, etc.
• Wealthier nations have currently "pre-purchased" massive quantities of promising vaccines to ensure they will be able to complete domestic vaccination. The US, UK, and EU have purchased FIVE TIMES the number of vaccines needed to immunized their entire populations.
• 50% of the vaccines expected in 2021 have already been bought up by the world’s wealthiest countries.
• Trump removed the US from the WHO who might ensure through funded programs the equitable distribution of the vaccine to poorer nations.
• Canada, UK, and others has joined a consortium, pledging to more equitably distribute the vaccine (COVAX), the US has not yet joined
•  the pandemic has pushed almost 37 million people into extreme poverty worldwide -limiting access to vaccines even more

• A vaccine for COVID-19 itself has become especially politicized

• Russia testing vaccines on scientists and China doing testing in the military-- Russia and China could use the distribution of a COVID-19 vaccine to poorer countries to try and sway political alignment. 
• Even in the extremely unlikely event that all five vaccines succeed, nearly two thirds (61 percent) of the world’s population will not have a vaccine until at least 2022. (OXFAM)
• “During a pandemic, vaccines and antivirals can’t simply be sold to the highest bidder. They should be available and affordable for people who are at the heart of the outbreak and in greatest need. Not only is such distribution the right thing to do, it’s also the right strategy for short-circuiting transmission and preventing future pandemics.”--Gates Foundation
• Gavi, the Vaccine Alliance, has been working since 2000 to address vaccine equity and helps vaccinate nearly half of the world’s children.While Gavi’s main focus is children, it has helped provide vaccines for people of all ages for epidemic-causing diseases such as yellow fever and meningitis. 
• Resolving these issues: (Harvard Business Review)
• Financing the purchase of vaccines
• One way to provide this financing is a bond structure backed by OECD countries that would allow the money to be raised in capital markets. 
• Supplemental donations by GAVI, OXFAM, BMGF and others
• Strengthening and protecting the health care workforce
• Some 1,700 health workers in Italy are known to have already been affected, decimating an overstretched health care workforce. 
• There are similar stories from Spain, and the same worrisome situation seems to be developing in New York City and other places in the United States. 
• Not only will this impede the treatment of patients inflicted with Covid-19, it will also affect the program to administer the eventual vaccine. 
• This could be an especially big problem in low- to middle-income countries, where the depletion of health care workers’ ranks could also weaken existing programs to vaccinate people against other diseases. 
•  Investment in personal protective equipment and testing capacity is needed to protect the global frontline workforce.
• Identifying residents of developing countries

• Around 1 billion people in the world — predominantly residents of developing countries — lack formal identities; many are mobile. 

• This presents a massive challenge for governments trying to reach a critical mass of dispersed people: Without reliable IDs, it’s difficult to know who has received vaccines. 

• The initial Covid-19 vaccine supply will be limited, so it will be essential to verify each dose reaches a real patient. 

• Corruption, leakage, and even accidental duplication waste precious supply and are deadly.

• biometric digital IDs can be a game changer. For example, Simprints has deployed biometric IDs on health and humanitarian projects across 12 countries, which have increased health care visits and quality while preventing fraud.
• Leveraging data to predict behavior
• need to understand risk of transmission at the hyperlocal level and the likelihood of adherence for specific geographies and sub-populations. 
• Establishing reliable supply chains

• need simple data-capture systems to understand the stock and flow of vaccines in the supply chain.

• Most vaccines need to be kept between two and eight degrees Celsius. 

• In many low- and middle-income countries, electricity sources are unreliable. New technologies can help. 
• Solar direct drive refrigerators, as well as efficient new ice-lined refrigerator technology, has revolutionized the cold chain in developing countries.  

To achieve all the things we have described, global coordination will be required. At least for the first eight to 12 months after the Covid-19 vaccine becomes available, it is likely that there will be only a limited supply to meet global demand. 

• There needs to be a global agreement on allocating stocks to countries around the world. If that doesn’t happen, the result will be political tensions like those we are currently experiencing over the allocation of personal protective equipment, ventilators, and test kits.
• Although the poorest countries have in place systems that have been well honed over 20 years through the Vaccine Alliance, middle-income countries ineligible for Gavi’s assistance do not.  We need to decide how to support them — whether to extend Gavi assistance to them or provide other mechanisms.

-----------------

Treatments, Drug Development and Inequality

• “Covid is all about privilege. The more privilege you have, the more you can ignore some of the rules of Covid. Where one person would need to be in the hospital, another person can have the hospital come to them. That’s privilege,” said Lakshman Swamy, an ICU physician at Cambridge Health Alliance in Massachusetts.
• The president’s privileged treatment is understandable given his prominence, (got treatment only 10 people have had access to).
• but the contrast is no less stark for millions of Americans who have faced down Covid-19 in their homes or local hospitals, where barriers to cutting-edge care do not simply melt at the mere mention of their names or job titles.
• “A portion of the people who are severely symptomatic don’t have access to health care … and they are the population that is just being decimated by this.”
• High-profile individuals — in particular, professional athletes — have had frequent access to testing with fast-turnaround results. For much of the rest of the population, however, confirming a case of Covid-19 has meant waiting in line for a test, and waiting even longer for results.
• Many patients are worried about losing their jobs because of a positive test, or afraid to go into the hospital because no one else will be available to care for their children if they’re admitted. So they stay home and try to ride it out.
• For ordinary patients, there is no such thing as a precautionary hospitalization. Unlike the president, they would not be admitted based on concerns about what could happen if they are not in close proximity to doctors and state-of-the art equipment. They are only hospitalized if signs of severe infection emerge.
• Data collected on Covid-19 cases have turned up significant disparities in who is infected — and who dies from an infection.
• Death rate is more than twice as high for Black patients, and nearly twice as high among patients identified as Native American or Alaska Natives. 
• The data also show that people with lower incomes are much more likely to become seriously ill. 
• About 35% of patients with household income under $15,000 became seriously ill, compared to just 16% of patients with income over $50,000.
• ordinary patients don’t necessarily get the everything-but the-kitchen sink care received by the president. 
• In addition to remdesivir and the antibody cocktail, the president’s physicians have also said he was given the steroid dexamethasone after a temporary drop in his oxygen levels. 
• getting access to Regeneron’s experimental drug, a cocktail of two monoclonal antibodies which has not yet been authorized by the FDA, is harder still. 
• Bateman-House said the bigger problem is that the process itself is not based on need. “We know who gets access to investigational medicine is not a random cross section of the American population,” she said, adding that many patients do not even know there is a way to apply. “This particular case of Trump just makes it real for people.”

Drugs (all gotten by Trump)

• Monoclonal Antibodies: 
• The treatment, called bamlanivimab, has been approved to treat non-hospitalized adults and children over age 12 with mild to moderate symptoms who have recently tested positive for COVID-19, and who are at risk for developing severe COVID-19 or being hospitalized for it.
• This includes people over 65, people with obesity, and those with certain chronic medical conditions. 
• The single-dose treatment must be given intravenously and within 10 days of developing symptoms.
• Monoclonal antibodies are manmade versions of the antibodies that our bodies naturally make to fight invaders, such as the SARS-CoV-2 virus. Bamlanivimab attacks the coronavirus's spike protein, making it more difficult for the virus to attach to and enter human cells.
• This treatment is not authorized for hospitalized COVID-19 patients or those receiving oxygen therapy. (could make them worse)
• Convalescent Plasma:
• Convalescent plasma — literally plasma from recovered patients — has been used for more than 100 years to treat a variety of illnesses from measles to polio, chickenpox, and SARS.
• antibody-containing plasma from a recovered patient is given by transfusion to a patient who is suffering from COVID-19. 
• The donor antibodies may help the patient fight the illness, possibly shortening the length or reducing the severity of the disease.
• patients with (or at risk of) severe COVID-19 who received convalescent plasma within three days of diagnosis were less likely to die than patients who received convalescent plasma later in their illness.
• In order to donate plasma, a person must meet several criteria. 
• They have to have tested positive for COVID-19, recovered, have no symptoms for 14 days, currently test negative for COVID-19, and have high enough antibody levels in their plasma. A donor and patient must also have compatible blood types. 
• Once plasma is donated, it is screened for other infectious diseases, such as HIV.
• Each donor produces enough plasma to treat one to three patients. 
• Anti-Viral Treatments
• remdesivir --The drug may be used to treat adults and children ages 12 and older and weighing at least 88 pounds, who have been hospitalized for COVID-19. 
• Clinical trials suggest that in these patients, remdesivir may modestly speed up recovery time.
• HIV protease inhibitors lopinavir and ritonavir, and lopinavir and ritonavir in combination with the immunomodulatory agent interferon beta-1a. (still experimental and not utilized)
• Steroid Treatments:
• dexamethazone -- the corticosteroid drug decreased the risk of dying in very ill hospitalized COVID-19 patients. 
• patients who have developed a hyper-immune response (a cytokine storm) to the viral infection--it is the immune system's overreaction that is damaging the lungs and other organs, and too often leading to death.
• when should it be started? 
• If you start too soon you blunt the body's natural defense system, and that could allow the virus to thrive. 
• Ibuprofen--Is it safe?
• Some French doctors advise against using ibuprofen (Motrin, Advil, many generic versions) for COVID-19 symptoms based on reports of otherwise healthy people with confirmed COVID-19 who were taking an NSAID for symptom relief and developed a severe illness, especially pneumonia. 
• These are only observations and not based on scientific studies. (anecdotal)
• Chloroquine, hydrochloraquine, and azithromycin
• patients with severe symptoms of COVID-19 improved more quickly when given chloroquine or hydroxychloroquine. 
• The jury is still out regarding whether these drugs, alone or in combination, can treat COVID-19 viral infection. 
• While recent human studies suggest no benefit and possibly a higher risk of death due to lethal heart rhythm abnormalities, two studies supporting these conclusions have been retracted by the authors because of irregularities in how results were collected and analyzed.
• Vitamin D

• There is some evidence to suggest that vitamin D might help protect against becoming infected with, and developing serious symptoms of, COVID-19.

• it may help boost our bodies' natural defense against viruses and bacteria. Second, it may help prevent an exaggerated inflammatory response, which has been shown to contribute to severe illness in some people with COVID-19. 
• people with low vitamin D levels may be more susceptible to upper respiratory tract infections. 
• Vitamin C
• No evidence it prevents COVID infection
• IV infusion may decrease death rate, but studies have not been conducted
• Zinc
• Helps the immune system fight off bacterial and viral infections
• Fatotidine
• The generic name for Pepcid, famotidine is commonly used to treat ulcers, heartburn, indigestion and reduces the amount of acid in the stomach. A clinical trial testing the drug in hospitalized COVID-19 patients in New York wasn't able to recruit enough patients to properly evaluate its impact
• Melatonin
• Commonly used to treat insomnia, some studies have suggested that melatonin could also help COVID-19 patients with diabetes and obesity
• Aspirin
• Commonly given to older patients to prevent heart disease, aspirin is also a popular painkiller. It can reduce the risk of blood-clotting, and evidence has shown COVID-19 can trigger blood clots in some patients. 

Testing:

• Seriologic Antibody Testing
• A serologic test is a blood test that looks for antibodies created by your immune system. There are many reasons you might make antibodies, the most important of which is to help fight infections. The serologic test for COVID-19 specifically looks for antibodies against the COVID-19 virus.
• Your body takes at least five to 10 days after you have acquired the infection to develop antibodies to this virus. For this reason, serologic tests are not sensitive enough to accurately diagnose an active COVID-19 infection, even in people with symptoms.
• good to find those who have been infected in the past and recovered
• Your body takes at least five to 10 days after you have acquired the infection to develop antibodies to this virus. For this reason, serologic tests are not sensitive enough to accurately diagnose an active COVID-19 infection, even in people with symptoms.

Drug Development and the Economics of Inequality

• “During a crisis, some people will go out of their way to sacrifice their lives, and others will hoard medicines and be complete jerks. On institutional levels, we have the same span of good actors and bad actors”
• in the absence of comprehensive trial coordination mechanisms, signs of disarray are emerging. 
• “The scale of these trials is too small, and the variation in terms of how they are being run is too large”, says John-Arne Røttingen, chief executive of the Research Council of Norway and proponent of a more collaborative approach. 
• “These trials aren't really designed to answer the questions that need to be answered.” 
• Clinical trial literature, moreover, is riddled with drugs that looked promising in small trials only to prove ineffective in bigger, more rigorous studies.
• Nine repurposed drugs, should they demonstrate efficacy against the coronavirus, could be manufactured profitably at very low costs, for much less than the current list prices.
• But: A course of sofosbuvir, a medication by pharmaceutical company Gilead Sciences that is currently used to treat hepatitis C, costs around US$5 to make, but the current list price in the US is US$18,610, as cited by The Guardian.
• “That’s been extremely common with infectious disease medications in the past, like hepatitis and HIV, and we can’t let it happen with medications for Covid-19. 
• Otherwise, hundreds of thousands of preventable deaths would occur and health care inequality amongst the poor will worsen,” said Dr Jacob Levi, one of the study’s authors
• Intellectual property policies in the U.S., Canada and other research powerhouse nations have prompted concerns over price gouging, geographic discrimination and other strategies that can lead to profit at the expense of affordable medicines. 
• While manufacturing a drug is generally cheap, the process of research and development costs much more. Various estimates place the cost anywhere between $300 million and $2.6 billion (though the higher figures are often disputed) per drug brought to market, and companies expect sufficient intellectual property protection on their marketed drugs to recoup these development costs. 
• This isn’t unreasonable to ask, and governments are happy to restrict competition for these companies as long as development and production of novel medicines continues. 
• Pharmaceutical companies are part of an industry that enjoys the largest profit margin compared to any other private industry, even surpassing oil and gas. 
• The ratio of revenue spent on promotion and marketing – upwards of 25 percent – compared to the 1.3 percent devoted to discovering new molecules is striking. 
• The pharmaceutical industry, in both domestic policies and under potential trade agreements like the TPP, is granted exclusive power over the market; companies rationally use this power to make as much profit as possible before their exclusive rights expire. 
•  Ten million people die each year due to a lack of access to essential medicines, and nearly three billion worldwide are at risk from diseases that lack market incentives for drug development. 
• The Commission on Health Research for Development found that less than 10 percent of worldwide resources devoted to health research were put towards health in low and middle income countries, where over 90 percent of all preventable deaths worldwide occurred.
• Although high drug prices as a result of the intellectual property system have long been identified primarily as a problem for developing countries, they are becoming a growing concern even for industrialized nations. 
• Pharmaceutical patents and exclusivity reduce access to lifesaving drugs, and allow technologies developed with public funding to be purchased and monetized by private entities in developed nations. 
• Taxpayer-sourced research funding from governmental organizations like the Canadian Institutes of Health Research or the National Institutes of Health is a major component of the R&D landscape. 
• Between one fourth and one third of new drugs originate on public university campuses, but are then bought out by the industry to be monetized. Though development costs are borne by the taxpayer, the benefits of the research are mostly enjoyed by private parties.

Comics and the Pandemic

 

--PLEASE READ THE FOLLOWING NARRATIVES ON THIS PAGE 

--AND THIS PODCAST: HERE

ILLNESS NARRATIVES: in Healthcare

The first classification, Arthur Frank:  Professor Frank classifies stories into three common story types: restitution, chaos and quest. 

• Restitution narrative: this is the story most favored by physicians and other medical professionals and poses the emphasis on restoring health. These narratives often have three moments: 
• they start with physical misery and social default, 
• continue with the remedy (what needs to be undertaken) and 
• finish with the moment in which remedy is taken; 
• moreover, the narrator describes how physical comfort and social duties are restored. 
• These are often stories told about patients rather than by patients, also because they give little agency to the narrator: patients simply have to ‘take the medicine’ and get well. 
• Chaos narrative, which is really a nonstory: there is little narrative drive or sequence, just a list of negative things that will never improve and by which the narrator is almost overwhelmed. 
• The story signals a loss or lack of control, and medicine cannot do anything. 
• Quest narrative: this is the teller’s story, where the teller is in control of things. Narrators tell how they met the illness ‘head on’ and sought to use it, to gain something from the experience; 
• the story is a kind of journey, with a recognized departure, an initiation (the mental, physical and social suffering that people have experienced) and a return (the narrator is no longer ill but is still marked by the experience).

The second classification, Arthur Kleinmann: , The concept trilogy of ‘illness’, ‘disease’ and ‘sickness’ has been used to capture different aspects of ill health. 

• Disease is defined as a condition that is diagnosed by a physician or other medical expert, and it is considered as alterations or dysfunction in biological and/or psychological process, a deviation from the recognized ‘normal’ state, an isolated malfunction of a body part; 
• ideally, this would include a specific diagnosis according to standardized and systematic diagnostic codes. 
• This also means that the clinical specific condition has a known biomedical cause and often known treatments and cures. 
• On the other hand, illness is defined as the ill health the person identifies themselves with, often based on self-reported mental or physical symptoms. 
• It refers to the lived experience, to how the ill person and the members of the family or wider social network perceive, live with and respond to symptoms and disability;
• it is something being lived through the body and can have many types of meanings, in different contexts, to different people. 
• Lastly, Kleinman introduces a third term, sickness. Sickness describes a disorder in a generic sense as applied to a population or group. It is related to a different phenomenon, namely, the social role a person with illness or sickness takes or is given in society, in different arenas of life, often used to measure social consequences for the person of ill health.

The third classification, Mike Bury: This type of classification foresees that analysis must consider three types of narrative forms: contingent, moral and core narratives. 

• contingent narratives are concerned with those aspects of the patient’s story that deal with beliefs and knowledge about factors that influence the start of disorder. 
• If this kind of narratives describes events, their proximate causes and their unfolding effects in relation to the performative of everyday life, moral narratives provide accounts of changes between the person, the illness and social identity and help to (re)establish the moral status of the individual or help maintain social distance, introducing an evaluative dimension into the links between the personal and the social. 
• Core narratives reveal connections between the person’s experiences and deeper cultural levels of meaning linked to suffering and illness.

The fourth classification, John Launer: Stories can be divided into three types: progressive, regressive and stable one. 

• Progressive narratives move towards the personally valued goals; 
• regressive narratives move away from such valued goals; and 
• stable narratives sustain the same position in relation to the valued goals throughout the narrative sequence. 
• This last kind of narrative could be seen as less engaging than others, because it tends to relate a sequence of events without great drama—a form of storytelling that goes under the heading of the so-called contingent narratives. 
• The use of a progressive, regressive and stable framework allows an analysis that safeguards against over-interpreting the range reserved of meanings conveyed by patients’ accounts. 
• whatever narrative form may be identified in analysis, many accounts move from one to another, for example, from regressive to stable. 
• Consistency in narrative accounts may be achieved or sought by patients, but it may not: much depends on the context in which narratives are constructed and presented and on the intentional acts which they help constitute. 
• This classification is very useful to focus on the coping strategies acted by patients: if regressive or stable narrative may show no positive engagement and if narratives are progressive, this may represent an evolving positively situation.

The fifth classification, factual language and symbolic language

• Factual language: digits, facts, visits, number of healed people, contaminated people, of deaths. Mechanism of action by the COVID-19. Rules, countries, decisions made, who visited whom, who was the patient 0, people seen by patient 1, dates of the outbreak, age by mortality rate, gender by mortality rate, immune children, number of available beds by Region, days of isolations- 14 and/or longer, number of potential contaminated people by one asymptomatic carrier, number of masks available, number of ambulances in the streets, spread and fall of the stock market value, number of closed activities, number of online new services, number of days spent in home working, volumes of purrell sold, potential time to vaccines,  and so on….
• Metaphoric language: try just to see on the screen shot the numbers of healed and deaths and contaminated as they are in the Frankfurt, Paris, New York London stock-exchange market by analogy
• Sontag argues, obscures illness within dramatic narratives, meant to rouse and inspire…through vigilance and alarm. The problem with stories, of course, is that the action only unfolds through the choices and responses of characters – that is, us – which in turn evokes assumptions about moral values and responsibility…about blame.If the disease wins the battle – does that mean the physician didn’t fight hard enough? that the patient didn’t have enough will to victory? or that, perhaps, the patient might even have inadvertently sabotaged her own defences, through insufficient vigilance, or morally lax behavior? And if contagion spreads, infecting, corrupting…whose unclean habits are to blame? who is the source of the pollution? Sontag makes the connections: our metaphors of illness tell stories of passive weakness, of malicious vice, of threat and danger, which we then use against one another. Never mind this pathogen, that imbalance of brain chemistry, this insufficiency of antibodies, that excess of cellular activity: we have others to blame (and “they” are always “other), others who can be the target of our shame, helplessness, fear, hatred. It might be a natural, human, impulse to use stories to give shape and meaning to otherwise arbitrary, uncontrollable phenomena; the danger is that the metaphorical thinking that we use to build those stories for our individual comfort then takes on a life of its own. The metaphors are especially vulnerable to ideological use, not at the level of the individual body, but of the body politic – the metaphors of invasion, pollution, sickness are used to justify the marginalization and separation of whole populations: Jews in 1930s Germany; gay men in 1980s America; immigrants, refugees, “aliens” (and their children) who threaten us with the infection of difference
• In addition, -the plague and plague spreaders. The cancer metaphor of the society has quietly faded away: now the new words are “infodemia”, “the viral decisions of politicians”.

• Albert Camus the plague: 

  “Flagella, indeed, are a common thing, but flagella are hardly believed to be when they fall upon your head. In the world there have been, in equal numbers, plagues and wars; and yet plagues and wars catch men always unprepared. (…) Stupidity always insists, we would notice if we didn’t always think of ourselves. In this regard, our fellow citizens were like everyone else, they thought of themselves, the scourge is not commensurate with man, we are therefore told that the scourge is unreal, it is a bad dream that will pass.”

The sixth classification, Plutchik emotions: Plutchik proposed that eight ‘basic’ emotions are biologically primitive joy, fear, anger, disgust, sadness, (the same as Inside Out) plus trust, surprise and anticipation. 

• Plutchik argued for the primacy of these emotions by showing each to be the trigger of behavior with high survival value, such as the way fear inspires the fight-or-flight response.
• Plutchik’s psycho-evolutionary theory of basic emotions has these main postulates: 
• 1. The concept of emotion is applicable to all evolutionary levels and applies to all animals, including humans. 
• 2. Emotions have an evolutionary history and have evolved various forms of expression in different species. 
• 3. There are a small number of basic, primary or prototype emotions. 
• 4. All other emotions are mixed or derivative states; that is, they occur as combinations, mixtures or compounds of the primary emotions. 
• 5. Each emotion can exist in varying degrees of intensity or levels of arousal. 

The moment that I was informed that we had become a COVID-19 department, I was devastated. This coronavirus is so frightening, and I knew that I could die from it. I am a person who needs to be in control, and I had lost control, I was so frightened. This entire new situation was scary—a situation of life or death. Moreover, I was in it. At the level of the team, we did not know what to expect, personally and collectively, as a department. I did not know what was expected from me as a social worker and what were the guidelines; everything was new. We created everything from the beginning, and I was scared.

Emma, a social worker in the hospital’s Corona Department

 “In our country, we know what a war is, and in the healthcare system we know how to function in the hospital during times of war, but still, this is a new war, a war that we have never handled, an invisible enemy, and it is frightening all of us.” In similar vein, Doron said: “to be significant, to be at the front is important. Before it was the army that was at the front, now it is the turn of the healthcare system to be at the front.” Sara, nurse

“In the Internal Medicine Department, I have been working for the past 18 years with my team, physicians, nurses, secretary—we have a common language. I felt especially secure in those days. How I will be able to use, in an efficient way, a new situation and new staff? This is ridiculous.” Dikla a nurse

“This will increase the feeling of insecurity…think that the entire situation is new and scary; so, what will I do without my friends who I have been working with for years?” In particular, the need to be protected during shifts was pronounced. As Sara told us: “In order to continue to come here, I need to feel that someone is taking care of me. I do not care who in charge of that in the hospital, but I need to feel safe; it is essential for me.” Tania, a social worker

“I cannot believe it… because of the workload… it is only because of the workload… I have to tell you that I haven’t eaten for whole days…I grab something. It is not that there isn’t any food, but we don’t have the time and the needs of the staff draw you and you can’t ignore them; you need to respond to each one. At other times its different, of course. Here you can’t say anything to them. It’s the mask; it creates wounds on their noses, so I brought them cream. This kind of mask or any other; so, I saw masks in the grocery store and I bought them pink surgical masks so they would feel joy. Every day I am bringing something to make them happy. All the time. Yes, the protective equipment is a problematic issue by itself… I understand since I am involved in that; it depends on the equipment that comes to Israel, but it is not always suitable… this equipment is insane.” -Julie, a nurse in the ICU

Julie’s “I Poem” I cannot believe I have to tell I haven’t eaten I grab something [to eat] I brought them cream I saw face masks I bought them masks I am taking out [something to make them happy] I understand I am involved

“I love my job, and I love the feeling of contributing. People around me, outside the hospital, talk about us [the HCWs]. I am in the frontline. It is pleasant and heartwarming.” -Michal, a nurse

Michal’s “I Poem”
I love [my job]
I love [the feeling of contributing]
I am [in the frontline]

“I believe this will continue …. I discovered the richness of family and personal life, which reinforced things that I knew about myself and my [hospital] family—we are sturdy and dedicated and we cope well. I am filled with appreciation for the Infection Management Department that created a safe environment.” --Dina, nurse

Dina’s “I Poem” I believe I discovered I knew [about myself] I am filled [with appreciation]

Themes: Trauma and Stress

A deceased is a deceased but the separation from the family is extremely difficult, the wrapping process is a different from what you normally do in the internal ward. In addition to the regular wrap we put them in a nylon wrap and that is horrifying. A really unpleasant sight. It is like you put your patients in a plastic bag and you close it with a zipper. And then you cover with another bag but from the opposite side. An unpleasant wrapping of a patient since it is supposed to be isolated.--Golda, nurse

Look, the coronavirus is something completely new. A whole new disease that we do not have a clue how to treat, how to behave with it … and the craziest thing [is] that no-one in the world has the knowledge how to treat this disease, no knowledge-based expertise, no medical literature. So, you are constantly calling your colleagues in the country and around the world. Then, you are planning how you will cope with your first coronavirus patient. And then you are planning your second patient and the third. The decisions [as the head of the ICU] are just on your shoulders. They said to me: you are crazy … you are crazy; what are you doing? But I had to listen to myself, my instincts, and I said I have to go with my feelings and intuition. The decision is all yours. And what is most crazy is that you do not know what will happen next. Now it [the patient’s condition] is fine and five minutes later the patient can die and there is no-one to consult with because no-one knows [anything] about COVID-19.--ICU Physician Marina

Themes: Security and Knowledge

At the beginning of the corona outbreak, there was a lack of food, protective gear, and clothes and shielding eyeglasses to protect ourselves. We had to shower between the shifts, and there was a shortage of showers in the hospital, and we had to fight for the basic needs to be protected, especially during the weekends. It was horrible. Everyone was terrified. There was a lack of food in the Corona Department. At the beginning, I did not have what to eat during the day. I felt broken and choked …. There were shifts that I did not eat for almost 12 h.--Orr, nurse

I did not have a life except the work at the hospital these past few weeks. I did not have a private life at all. I did not meet my family. I am tired all the time, I just want to sleep like a human being, to eat, to be away from the hospital and from the Corona that is all over; these 12-h shifts killed me. I am a single mother and I have a daughter. My daughter was all by herself at our house. It is unbearable; she was all by herself for all those days of the corona, and I was here taking care of other people.--Sara, nurse

There was constant anxiety and fear that we would infect others; we [at the Corona Department] felt like lepers … and then the isolation from my family since I was so afraid that I would infect them. I was isolated like a leper. My children could not go out to play with other children because I was terrified that I would infect my children and that they would infect their friends with coronavirus. At the beginning of the coronavirus, my daughter was so stressed out from this crazy situation.--Dorit, nurse

“The Head of the Department is constantly updating us … I do not feel detached … I feel secure, knowing where I stand.” --Dan

“ … a lack of communication and information about what is happening at the hospital at the general level and not at the sector level bothers me. I am worried.” Avi, administrator

“Uncertainty concerns me—assessments of the situation and updates by my immediate supervisor would help me.”  “I feel like I’m in the dark and don’t know what’s going on.”--Ruth

Theme: Need for Belonging

We were all a big family helping each other. I felt so close to all my peers; working together in such a tough time was different from what I had known in the last 26 years that I have been working in the hospital. As a team, we have become closer to each other, and I have discovered additional angels in my team …. In our department there is a sense of “togetherness” and comradery. Professionally, there will be changes; there are thoughts about modifying procedures in light of the current pandemic …. Relating to each other, currently feeling that we are a united and cohesive group.---Vicki, administrator

This period is a mixture of emotions. The reality is that everything is so new and unfamiliar. Nevertheless, the staff are so devoted to each other and struggling to do their best to help each other and changing shifts due to the lack of nurses. Sometimes they asked about treatment and I did not have an adequate answer. How I will say it? This is the period that we are re-inventing the protocols and rules of treatment. I am telling them that I am so sorry but there are no guidelines yet.--Pam, ICU nurse

“A good word, a compliment, and a positive attitude made me feel valued and…reassured.” “A kind word makes my day …. It is essential for me to get feedback on my work and to know that I am doing my job well.”--Lori, nurse

“The presence of management in all departments and during all shifts made the staff aware that there was someone with them.” She added: “Personal appreciation by the management increases motivation and reduces concern….I would like to see more direct communication with management… in my team, I feel appreciated. I don’t feel I’m getting feedback from management.” --Alma

Management worked well during the crisis; I want to thank the management for the adaptions that were made by mobilization of staff and change of policies and for taking the time to listen; and in my opinion, the hospital and management are doing well.--Dan, assistant nurse

Theme: Meaningfulness

“Patients with coronavirus helped me to feel valued and meaningful, [especially] the conversations with the patients and the phone conversations with their families out there in their homes, so worried about their loved ones. I was there for the patients and their families, and it allowed me to feel meaningful and to want to continue treating patients.”--Carol, nurse

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